It can be hard to know what to say or what to do - how to be there for them.

I learned this a few months ago, when a close friend in my hometown of Sacramento was diagnosed with breast cancer.

It's been a learning curve. Turns out you don't always have to know what to say; sometimes it's about what not to say.

Sometimes it means holding onto your words for a few seconds before uttering them, just to make sure you're not saying something hurtful or insensitive.

The lesson began when a friend called and told me Janet was undergoing chemotherapy, and he thought she would like to hear from me.

After I left a series of awkward messages on her answering machine, she finally picked up one day.

As we began talking, I felt inadequate to say anything comforting or helpful - but I soon relaxed. She had a great attitude and seemed optimistic, even cheerful. She talked about a trip to Italy she planned with her mother after she completed radiation therapy in the fall.

She spoke about her treatment, and the changes and issues it had brought to her life, and something she said struck me. She said sometimes, meaning to be comforting, people told her breast cancer was "a gift."

To which she responded, "No thanks" - if it was a gift, she'd rather return it.

While many survivors find strength, faith, inner resources and renewed connections with family and friends along the way, for which they are grateful, cancer is the enemy.

Winslow, 68, who was diagnosed in February 2011, speaks not just from her own experience, but from years of working with breast cancer support groups, which she did in her capacity as a registered nurse and advocate of early detection.

Even if some cancer patients do choose to see the disease as a gift or blessing, it's a bit like talking about your mama: It's OK for you to say things about her, but rude for anyone else.

Winslow said another thing to avoid is cancer war stories.

Hearing about someone else's horrible experiences doesn't do much to lessen a cancer patient's fears, even if the story has a happy ending.

"It's the last thing you want to hear," she said, adding that it can sound like "It's really no big deal, I know people who have it a lot worse than you," which is not very helpful to someone grappling with the fear and trauma of a life-threatening disease.

Cancer survivors often cite the support and friendship of family in friends as the most helpful thing to them in their battle against the disease.

For Beulah Vital of Orange, being able to talk about her fears in the early stage of her diagnosis was important, as was a positive response to those fears.

"I didn't have that negativity around me," she said. "Everything was always positive. I didn't want that negativity. I had my support group telling me things I needed to hear. Everybody was being positive."

But don't let worries about saying the wrong thing keep you from calling or visiting. If you don't know what to say, maybe you can ask them if they want to talk, and just listen.

Winslow said just picking up the phone and making the call is a step in the right direction.

"Most people have a tendency to stay away," she said. "It's one of the most difficult times."

She advised against general offers like, "if there's anything I can do, just ask," in favor of more targeted ones.

Things like, "Do you need a ride to treatment?" or "Can I bring dinner for your family" or "When can I watch your kids?" are more useful.

Winslow said she never drove alone to her treatments at M.D. Anderson, though she was physically capable of it.

"I cannot tell you how much I enjoyed spending time with a good friend," she said.

Brenda White, another Beaumont survivor, had similar recommendations - hearing from her friends helped give her confidence and encouragement, and offers to stay with her in Houston at a hospitality house where she stayed during her treatment there were invaluable.

Having a friend or relative with you during doctor visits can be extremely important, Winslow said.

People "have a tendency not to hear everything the doctor says to them," she said, adding that she was stunned by the things her daughter said that she'd missed during her doctor visits.

"It's a common thing in any illness," she said.

Winslow said it's probably a good idea for cancer patients to have a relative or friend be the one to spread the word when they are ready to let others know about their diagnosis.

Some people find it difficult to ask for the help they need, and in any case may be so engrossed in absorbing their diagnosis and prognosis they have about all they can handle at the moment.

"It's a peculiar position to be in," Winslow said. "Someone really needs to take charge and let friends know."